SANS Anatomy Flashcards
Sebuah pandangan lateral dari permukaan cortical yang membatasi bagian kanan sylvian fissure yang biasa terlihat dalam craniotomy frontotemporal ditunjukkan dalam gambar 1. Bagian ujung bawah dari gyrus precentral (1) dan postcentral (2) terlihat. Gyrus supramarginal ditunjukkan oleh nomor :
A. 9
B. 5
C. 6
D. 8
E. 7
E. 7
The surface of the inferior frontal gyrus is formed, from anterior to posterior, by the pars orbitalis (6), pars triangularis (5), and pars opercularis (4). The precentral gyrus (1) is positioned just behind the pars opercularis. The area below the lower apex of the pars triangular (4), which is commonly retracted upward, away from the sylvian fissure, is the widest point along the fissure and a suitable point to begin opening the fissure. The postcentral gyrus (2) is located just anterior to the supramarginal gyrus (7), which wraps around the upturned posterior end of the sylvian fissure. The angular gyrus (8) is behind the supramarginal gyrus. The lower part of the pre- and postcentral gyri are commonly exposed at the posterior-superior edge of a frontotemporal craniotomy in the area between the pars opercularis and the supramarginal gyrus. The transverse temporal gyri on the opercular surface of temporal lobe produce prominences (9 and 10) along the lower margin of the sylvian fissure at their lateral end. The most anterior of these is Heschl gyrus (9). A gyral bridge (3) commonly connects the lower ends of the pre- and postcentral gyri and separates the lower end of the central sulcus from the sylvian fissure.
Bill’s bar memisahkan nervus facial dari struktur lain apakah ?
A. Greater Superficial Pertrosal Nerve
B. Geniculate Ganglion
C. Superior Vestibular Nerve
D. Inferior Vestibular Nerve
C. Superior Vestibular Nerve
Bills bar is a bony ridge that separates the facial nerve from the superior vestibular nerve.
The transverse crest is a bony structure that separates the facial nerve and superior vestibular nerve from the cochlear nerve and inferior vestibular nerve. There is no named structure that separates the cochlear nerve from the inferior vestibular nerve. The greater superior petrossal nerve arises from the facial nerve at the region of the geniculate ganglion.
Gambar berikut adalah diseksi cadaver pada bagian anterior dari sinus cavernous kiri. Defisit apakah yang dapat terlihat untuk kerusakan pada struktur ini ?
A. Baal kulit wajah
B. Diplopia yang dapat dikoreksi dengan head tilt
C. Baal kulit sekitar periocular
D. Ptosis, miosis, dan anhydrosis
E. Kebutaan monocular
D. Ptosis, miosis, dan anhydrosis
The arrow indicates the ascending sympathetic fibers coursing along the internal carotid artery. Horner syndrome involves the triad of ptosis, meiosis and anhydrosis as a result of loss of sympathetic innervation of the eye and face. The primary sympathetic nerves to the face synapse in the intermediolateral horn of the upper thoracic spinal cord. The secondary sympathetic nerves ascend the sympathetic chain and synapse at the upper cervical ganglia. The tertiary sympathetic nerves then follow the internal carotid artery intracranially and subsequently join with the oculomotor nerve to innervate the pupillary dilator muscles.
Periocular numbness would arise from damage to the superior branch of the trigeminal nerve. Diplopia that corrects with head tilt would arise from damage to the trochlear nerve. Facial numbness would arise from damage to the entire trigeminal nerve. Monocular blindness would arise from damage to the optic nerve.
Gambar berikut memperlihatkan sebuah pandangan endoscopic dari daerah clival/retrosellar bagian atas dalam diseksi cadaver. Nervus cranial apakah yang ditunjukkan oleh nomor 1 :
A. Trochlear
B. Oculomotor
C. Optic
D. Trigeminal
E. Abducens
B. Oculomotor
Structure 1 is the right oculomotor nerve. This nerve exits the ventral midbrain typically between the posterior cerebral artery (PCA) and teh superior cerebellar artery (SCA).
Structure 2 is the left superior cerebellar artery which supplies the tentorial surface of the cerebellum.
Structure 3 is the tuber cinereum, the typical location for an endoscopic third ventriculostomy.
Structure 4 is the left posterior communicating artery (pComm), which joins the posterior cerebral artery to the supraclinoid internal carotid artery. It crosses the plane of the optic tract as shown in the picture.
Structure 5 is the left uncus. This structure includes the parahippocampal gyrus and can be involved in herniation syndromes.
3 hari setelah tindakan clipping untuk kasus ruptured anterior communicating artery aneurysm, seorang pasien menunjukkan perkembangan paresis contralateral pada lengan dan wajah, juga dysarthria. Sebuah cerebral angiogram memperlihatkan adanya vasospasm focal yang akhirnya memberikan hasil infark pada teritorial vascular yang berkaitan, yang dikonfirmasi juga oleh CT. Pembuluh darah apakah yang paling mungkin dipengaruhi oleh vasospasm pada kasus ini ?
A. Reccurent artery of Heubner
B. Anterior choroidal artery
C. Distal anterior cerebral artery
D. M1 branch of the middle cerebral artery
E. Posterior communicating artery
A. Reccurent artery of Heubner
The recurrent artery of Heubner (also known as the medial distal striate artery) arises just distal (and less commonly proximal) to the anterior communicating artery. It supplies the head of the caudate, anterior limb of the internal capsule, anterior putamen and globus pallidus, the septal nuclei, and the inferior frontal lobe. It is termed “recurrent” due to its course from its origin backwards towards the ipsilateral proximal A1. The artery is often at risk of injury during surgical treatment of an anterior communicating artery aneurysm and may develop subsequent vasospasm. Compromise of blood flow in the recurrent artery of Heubner classically results in contralateral arm and face weakness, and occasionally dysarthria. Bilateral injury results in akinetic mutism. The CT image demonstrates infarction of the caudate head and internal capsule resulting from vasospasm of the recurrent artery of Heubner.
Involvement of the distal anterior cerebral artery would result in infarctions in paramedian cortices. Vascular compromise of the anterior choroidal artery primarily affects the posterior limb of the internal capsule. Compromise of the M1 branch would result in hemispheric infarction throughout the middle cerebral artery territory. Finally, compromise of the posterior communicating artery may or may not result in infarction, depending on collateral flow through the posterior circulation.
Artery apakah (ditunjukkan oleh tanda panah dalam Gambar 1) yang ditemukan selama pendekatan retrosigmoid untuk kasus vestibular schwannoma ?
A. Superior cerebellar artery
B. Anterior inferior cerebellar artery
C. Posterior inferior cerebellar artery
D. Vertebral artery
E. Basilar artery
B. Anterior inferior cerebellar artery
The anterior inferior cerebellar artery (AICA) is most at risk during resection of a vestibular schwannoma regardless of approach. It can have a variable orientation in the CPA and meatus. In up to 40% of the cases it may actually be deep inside the IAC thus making it vulnerable to injury even via a middle fossa approach.
Struktur apakah yang melalui foramen yang ditunjukkan oleh tanda panah putih ?
A. V2
B. V1
C. Vidian nerve
D. V3
E. Optic nerve
A. V2
V2 travels through the foramen rotundum, which is the structure identified in the coronal CT in the figure. The foramen showed immediately inferior and medially located inside the sphenoid bone is the pterygoid canal, which contains the vidian nerve. The superior orbital fissure (SOF) is seen above the foramen rotundum and the optic canal is seen above the SOF.
Manakah dari struktur di superior orbital fissure berikut yang melewati sekitar annulus of Zinn ?
A. Nervus nasociliary
B. Cabang inferior dari nervus oculomotor
C. Cabang superior dari nervus oculomotor
D. Nervus abducens
E. Nervus trochlear
E. Nervus trochlear
The correct answer is the trochlear nerve. Four structures pass lateral to the annulus of Zinn in the superior fissure. These structures are the lacrimal nerve, the ophthalmic vein, the frontal nerve and the trochlear nerve. Both inferior and superior branches of the oculomotor nerve pass through the annulus of Zinn as does the abducens nerve and the nasociliary nerve.
